I grant my consent to Gale N. Touger, RN, IBCLC to observe me breastfeeding and to examine my breasts, and to observe and examine my baby during the period of lactation assistance. I understand that all medical care is to be provided by my/our own physician(s).

I grant permission to Carolina Lactation Consultants, LLC to share pertinent information about this consultation with my/our health care providers, the referral source, my community breastfeeding helper, my insurance company and as appropriate to further the knowledge of breastfeeding.